With the Supreme Court’s ruling to uphold the constitutionality of the Affordable Care Act (ACA), the GOP’s continued call to repeal the ACA (see blog article), and the current political debates with the upcoming election, a slew of both facts and fiction are being thrown to the public. Most people have no clear way to discern what is true and what is false, and fraudsters, among others, are tapping into this confusion. This article highlights a new fraud scheme resulting from the ACA, and outlines the basic facts about how health care reform impacts people with Medicare, people with other insurance, and people with no insurance.

A warning on health care fraud

Scam artists have quickly taken advantage of the confusion resulting from the Supreme Court’s recent ruling to uphold the ACA in devising their schemes to defraud Medicare and its beneficiaries. In a current scheme highlighted in a Federal Trade Commission’s consumer alert, they call beneficiaries while claiming to be from the government. They often say that due to the ACA, they need to collect some of their personal information, such as their Medicare number, Social Security number, or their bank account or credit card number.

This is a good opportunity to remind beneficiaries how to protect themselves from fraud by:

Not giving out any personal information to people they do not know, especially unsolicited callers;

Carefully reviewing their Medicare Summary Notices; and

Reporting suspicious or potentially fraudulent services.

By just taking these simple steps, people protect both their identity and Medicare’s integrity. Call ourSenior Medicare Patrol to report any suspected fraud or for assistance with any questions regarding fraud at 1-855-613-7080. See our website for more information on Medicare fraud.

People who currently have insurance gain many protections under the ACA, including:

Insurance companies cannot drop coverage if a person gets sick;

Companies must justify premium increases;

Children under age 19 cannot be denied coverage for a pre-existing condition;

No lifetime limits are allowed on a person’s coverage; and

Starting in 2014, companies cannot place annual limits on a person’s coverage.

As for Medicare, the ACA also requires that insurance companies cover many preventive services without cost-sharing, such as:

Mammograms;

Immunizations including influenza, pneumonia, Hepatitis and others; and

Screenings for cancer or diabetes.

People who are currently uninsured or paying for their own coverage will see the creation of Health Insurance Exchanges by 2014. These Exchanges will create a more organized and competitive market for health insurance by offering a choice of plans, establishing common rules regarding the offering and pricing of insurance, and providing information to help people better understand their options and make it easier for them to compare plan benefits and costs. (See one of Kaiser Family Foundation’s documents on Exchanges for more info.)

The ACA also extends coverage to young adults who can now stay on their parents’ coverage until age 26, regardless of whether they live with their parents, are married, or are not longer in school.

In addition, the ACA provides a Pre-existing Condition Insurance Plan (PCIP) in each state to make sure people who have a pre-existing condition and have been without coverage for at least 6 months, or have been denied coverage because of their health condition, have access to coverage. These PCIPs cover a broad range of health benefits, including primary and specialty care, hospital care, and prescription drugs. Premiums are based on the subscriber’s age, region of residence and plan choice. Those who apply for a PCIP must prove they are not entitled to any other type of coverage.

Conclusion

The Affordable Care Act is a significant historical piece of legislation and a contribution to the well-being of our citizens. It greatly enhances people’s access to affordable, quality health care, and improves and increases the benefits and protections for Medicare beneficiaries. At the same time, it includes initiatives to reduce the costs of health care. California Health Advocates supports the continued implementation of this important law and aims for all Californians to have accurate information and facts on what the ACA provides. For additional information on health care reform, see:

About Karen Fletcher

Our blogger Karen J. Fletcher is CHA's publications consultant. She provides technical expertise, writing and research on Medicare, health disparities and other health care issues. With a Masters in Public Health from UC Berkeley, she serves in health advocacy as a trainer and consultant. See her current articles.

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